Healthcare Provider Details

I. General information

NPI: 1801741038
Provider Name (Legal Business Name): MICHAEL DORAN NAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 WOODRIDGE LN
GRAND BLANC MI
48439-9049
US

IV. Provider business mailing address

6150 WOODRIDGE LN
GRAND BLANC MI
48439-9049
US

V. Phone/Fax

Practice location:
  • Phone: 810-348-1011
  • Fax:
Mailing address:
  • Phone: 810-348-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberN460603149440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: